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Angiosomes: how do they affect my treatment?
Luis Mariano Palena1, Luis Fernando Garcia2, Cesare Brigato1
1Interventional Radiology Unit, Policlinico Abano Terme, Paduva, Italy.
Insights
Diabetic critical limb ischemia (CLI) is a growing global health concern. Endovascular revascularization, particularly targeting wound-related arteries, offers a promising approach to healing diabetic foot ulcers and preventing amputations.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Diabetology
Background:
- Rising global diabetes prevalence increases critical limb ischemia (CLI) and diabetic foot disorders.
- Diabetic occlusive arterial disease poses a significant challenge for vascular specialists.
- Revascularization is crucial for wound healing and amputation prevention in diabetic patients.
Purpose of the Study:
- To summarize endovascular treatment experience in diabetic CLI.
- To focus on the angiosome and wound-related artery model for revascularization.
- To highlight technical challenges in treating infrapopliteal and pedal vessels.
Main Methods:
- Review of endovascular revascularization strategies for diabetic CLI.
- Application of the angiosome and wound-related artery model.
- Analysis of technical difficulties in below-knee and below-ankle interventions.
Main Results:
- Endovascular treatment can reestablish adequate blood flow to ischemic areas.
- Targeting specific angiosomes ensures direct perfusion to diabetic foot wounds.
- Successful revascularization improves healing rates and reduces amputation risk.
Conclusions:
- The angiosome-guided approach is effective for diabetic CLI.
- Addressing below-knee and below-ankle vessels presents unique technical challenges.
- Multidisciplinary management is key to optimizing outcomes in diabetic limb salvage.
Abstract:
The number of diabetic patients is actually increasing all around the world, consequently, critical limb ischemia and ischemic diabetic foot disorders related to the presence of diabetic occlusive arterial disease will represent in the next few years a challenging issue for vascular specialists. Revascularization represents one step in the treatment for the multidisciplinary team, reestablishing an adequate blood flow to the wound area, essential for healing and avoiding major amputations. The targets of revascularization can be established to obtain a "complete" revascularization, treating all tibial and foot vessels or following the angiosome and wound-related artery model, obtaining direct blood flow for the wound. In this article, we summarize our experience in endovascular treatment of diabetic critical limb ischemia, focusing on the angiosome and wound-related artery model of revascularization and the technical challenges in treating below-the-knee and below-the-ankle vessels.
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